Erectile Dysfunction

The treatment of erectile dysfunction is our primary area of interest. This problem is very common and affects 52% of men at age 50 years. Unfortunately, this area has been heavily targeted with both misleading information and deceptive advertising. Patients need to be evaluated by a Urologist, who not only specializes in this area, but who is able to address all of the associated Genito-Urinary issues. And they need to be able to offer all of the available treatment options.

All causes of impotence can be treated successfully. There is no one answer which is right for every patient. But there is a choice that is most appropriate for you.

Our seamless, and effective, approach has been specifically designed to minimize the time, and the extent, of the evaluation required. This has also been designed to maximally ensure your privacy and confidentiality.

We offer a large range of treatment options that are based on both efficacy and safety; any protocol, or therapy, that does not meet these criteria is not considered or included.

  • Medication by Mouth (Viagra, Cialis, Levitra, Stendra etc.)
    • Please note that responses can be idiosyncratic and need to be individualized.
  • Vacuum Erection Devices
  • Penile Traction Devices
  • Penile Injection Therapy (PGE1, BiMix, TriMix)
    • Self administered injection — must prepare immediately prior to use, the medications usually require cold storage which may pose a logistical challenge
    • Injection technique is usually very easy to learn — involves both drawing up the medication and then doing the injection, almost always learned in only one teaching session, topical local anesthetic almost never used as this could inadvertently impair the partner’s sensation
    • Not indicated if there is a needle phobia or sometimes if anti-coagulated
  • Penile Wearable Devices (Elator, Xialla etc.)
  • Penile Implants
    • Our extensive experience addresses all the subtleties that need to be considered in order to achieve the desired results
  • Botox (Bocox™ or BoPriapus™)
    • NOT self-injectable and requires a Urologist for administration
    • Enhances fullness of erections, improves response to oral medications and helps restore erectile function when oral medications begin to fail
    • Appears to enhance both LI-ESWT and the P-Shot™ so often used together
    • Improvement can last up to a full year
  • LI-ESWT (Low Intensity Extracorporeal Shock Wave Therapy)
    • Treatment is safe, is an in-office procedure, can be used in conjunction with and also enhances other treatments
    • FDA-approved off label (and can be used even if anticoagulated)
    • Over 79% effective in improving erectile dysfunction
    • The preferred device is the Spark Wave (Urogold 100) designed by the maker of Shock Wave therapy devices for the treatment of kidney stones and felt to be the best available device
    • Note: Please avoid acoustic or radiofrequency treatments which are popular but ineffective. Many of the machines currently marketed are ballistic radial devices: EPAT (Extracorporeal Pulse Activation Technology) and (RSWT) Radial Shockwave Therapy and do not produce a true medical shockwave according to the (ISMT) International Society for Medical Shockwave Treatment
  • P-Shot™ (also called a Priapus shot)
    • Uses the patient’s own activated platelet rich plasma
    • Office-based procedure, platelets are extracted from the patient’s own blood, then activated, and then safely re-injected into the numbed penis
    • Improves both erectile function and sensation, this enhances other treatments so they are often used together
  • P-Shot 50™ and P-Shot 100™
    • When either 50 units, or 100 units, of Botulinum Toxin A are used along with the P-Shot™
    • Improves the effectiveness, and possibly the durability, of the P-Shot™
    • FDA approved but off label, but also off label when used on the face
    • Very safe
  • P-Long™
    • P-Long™ is a protocol designed for penile enhancement intended to increase length, girth and rigidity
    • Based on a pilot study of small sample size and marginal design: preliminary but promising results, no adverse effects (awaiting quality confirming studies)
    • Consists of four treatment components:
      • P-Shot™ once a month for 6 months
      • Traction devices used  — RestoreX 20 minutes twice a day… to increase length with an average gain of 0.85 inches after 6 months
      • Vacuum devices used  — Joel Caplan vacuum device 12 minutes twice a day… to improve girth with an average gain of 0.47 inches after 6 months
      • Affirm Dietary Supplement — contains a Nitric Oxide precursor, 1 tablet twice a day for 6 months, possibly improves penile blood flow, made and marketed by one of the study designers, efficacy unknown
    • Impression — a promising start that can likely be improved but appears very safe to use
  • Treatment options not offered
    • Penile Fillers, bulking agents, to increase girth only
      • Usually of dermal or fat origin
      • Some trademarked (eg. UroFill™, this product does allow some sculpting and modeling)
      • Lack durability and often results in residual deformities requiring surgical correction
    • Division of the suspensory ligament of the penis
      • Results in a destabilized penis
      • Changes the cosmetic appearance, penis hangs lower and may appear longer, but the actual length remains unchanged
    • Penuma (for enhancing girth only)
      • Permanent synthetic filler
      • Requires surgical implantation
      • Changes cosmetic appearance to a “pig in a blanket” effect
      • Significant rate of adverse outcomes, dissatisfaction and subsequent surgical removal

Impotence is reversible. You do not have to accept erectile dysfunction. There is no one but answer which is right for every patient – there is a choice that is right for you.